Caring for

a patient with a

bowel ob

30 LPN2007 l Volume 3, Number 5

struction Bowel obstructions can occur at all ages
and for a variety of reasons, and they’re
more prevalent than you might think—in
the United States, 12% of all hospital
stays involve patients diagnosed with
2.0
CONTACT HOURS

bowel obstructions. Early intervention is

vital, so you need to recognize the signs
and symptoms to help ensure that your
patient has a positive outcome.
VICKY P. KENT, RN, CNE, PHD
Clinical Associate Professor • Department of Nursing • Towson University
• Towson, Md.

The author has disclosed that she has no significant relationship with or
financial interest in any commercial companies that pertain to this education-
al activity.

HOW URGENT A PROBLEM is bowel obstruction? Most

patients with this condition are admitted to the hospital
through the emergency department, and 10% to 20% of
them are acute surgical cases. Because a bowel obstruc-
tion can be deadly if not treated promptly, it requires
precise identification for proper treatment. In this article,
I’ll review what a bowel obstruction is, what causes it,
the signs and symptoms to look for, and how to care for
a patient who presents with this diagnosis.

What’s a bowel obstruction?

A bowel obstruction, or intestinal obstruction, is any-
thing that stops, delays, or changes the advancing of
solid and liquid material through the small and/or large
bowel. Treatment for bowel obstructions ranges from
medical management to surgical intervention.
Bowel obstructions are classified as mechanical or non-
mechanical (also called a functional obstruction), partial or
complete, and acute or insidious. Their signs and symptoms
JOHN MARTIN

differ, according to their category, position, and severity.

Initial indicators of a bowel obstruction can include a feel-
ing of fullness, a swollen or stretched abdomen, nausea,

September/October l LPN2007 31
 mild or severe vomiting, stomach
cramps, an absence of bowel sounds
or high-pitched and resonant
sounds, and diarrhea or constipation.
First, let’s review the two types of
bowel obstructions—mechanical and
nonmechanical.
It takes two
A mechanical bowel obstruction is some-
thing that decreases the diameter of
the bowel’s opening from either the
inside or outside. It physically blocks
the movement of material through
the intestines. Possible mechanical
obstructions could be due to:
• scar tissue (adhesions) from previ-
ous surgery
• hernias
• malignant tumors
• foreign bodies such as gallstones
• twisting of the bowel (volvulus)
• telescoping of the bowel (intussus-
ception)
• fecal impaction
• Crohn’s disease.
In a simple mechanical obstruc-
tion, ingested liquids and food,
digestive secretions, and gas accumu-
late above the obstruction. The
proximal bowel enlarges and the dis-
tal bowel collapses. Normal bowel
function decreases, and the bowel
wall becomes edematous and con-
gested. Blood flow to the intestines is
also impaired, which can cause the
tissue to die. This can lead to bacter-
ial infection, sepsis, dehydration, and
electrolyte abnormalities.
A nonmechanical bowel obstruction is
caused by something that decreases
the muscle action of the bowel and
affects the ability of fecal matter and
fluid to move through the intestines.
A nonmechanical obstruction could
be related to:
• poor blood flow to the intestine
caused by an embolus or thrombosis
of the mesenteric artery or anything
that disrupts circulation of blood to
the intestine
32 LPN2007 l Volume 3, Number 5
• a disturbance of the nerves or
muscles due to injury to the sympa-
thetic nervous system that reduces
the frequency of the bowel's tight-
ening and expanding (peristalsis)
• previous abdominal surgery
• bowel perforation
• sepsis
• peritonitis
• blunt abdominal trauma
• peptic ulcer disease
• anticholinergic drugs, which can
dry out the mucous membrane and
decrease peristalsis
• pain medications, especially opioid
and opioid-like medications, which
slow the regularity of the bowel’s
functioning
• diuretics, which deplete potassium
and can disturb peristalsis (potas-
sium helps regulate smooth muscle
function; any diuretic that decreases
potassium may lead to impaired
peristalsis).
Additional classifications
Bowel obstructions can also be classi-
fied as being partial or complete. A
partial bowel obstruction indicates
that some, but not all, of the food
and air in the intestines can move. A
complete bowel obstruction indicates
complete blockage, and no food or
air can move through the intestines.
Two more classifications for
bowel obstructions are acute and
insidious. Acute bowel obstructions
cause a rapid onset of cramps,
abdominal distension, vomiting, and
severe constipation. Insidious
obstructions develop over a period of
weeks and are more often associated
with large bowel obstructions.
The location of a bowel obstruc-
tion is important in making a proper
assessment. Let’s look at where they
can occur.
Location, location, location
Most mechanical obstructions
(80%) occur in the small bowel.
Small-bowel mechanical obstruc-
tions are usually caused by:
• surgical or nonsurgical adhesions
• hernia
• Crohn’s disease
• intussusception
• parasites.
Large-bowel mechanical obstruc-
tions are less common (20%) and are
usually caused by:
• diverticulitis
• volvulus
• a malignant tumor
• constipation.
Small- and large-bowel obstruc-
tions cause similar symptoms,
although the intensity of discomfort
and pain varies. Let’s examine the
clues that can help determine if your
patient has a bowel obstruction.
Assessing the obstruction
Upon first assessment, a patient
with a small- or large-bowel ob-
struction may have the symptoms
already described plus the following
signs and symptoms:
• fever
• dehydration
• low blood pressure
• lethargy
• decreased urine output (oliguria)
• tenderness of the abdomen with
palpation
• guarding of the affected areas.
If the condition worsens, the
patient may also begin to exhibit
signs and symptoms of fluid and
electrolyte imbalance and possibly
metabolic acidosis or alkalosis.
Along with these basic signs and
symptoms, patients will have other
symptoms depending on whether
they have a small-bowel or large-
bowel obstruction. Here’s how to tell
the difference.
Signs and symptoms of
small-bowel obstruction
Patients with a small-bowel obstruc-
tion will usually have the following
signs and symptoms.
Abdominal pain. The patient with
a small-bowel obstruction presents
with a pain that can be cramp-like or
colicky. The pain is episodic and
generally occurs in the mid-to-upper
abdomen. If the obstruction is par-
tial, the pain worsens right after the
patient eats and improves with diges-
tion. Distention and generalized dis-
comfort without colicky pain may
indicate a lack of movement in the
intestines caused by paralysis of the
bowel (paralytic ileus). Sometimes
the patient gets pain relief after
changing position or vomiting.
Nausea and vomiting occur as a
result of increased peristaltic activity,
but the intestinal contents reverse
direction instead of moving forward.
The vomiting is often projectile,
especially if there’s obstruction high
in the small bowel. Another sign of
obstruction high in the small intes-
tine is vomit that’s odorless or looks
or smells like bile (a greenish yellow
fluid that has a bitter, offensive
odor).
In small-bowel obstructions, a
patient will experience abdominal
distention, a feeling of fullness, and a
change in bowel sounds. The sounds
range from hyperactive bowel

Some sound advice

Follow these tips for assessing bowel sounds:
• Listen to all four quadrants of the abdomen.
• You should be able to hear some bowel sounds at least once every 5 to 15 seconds. They might last one to a few seconds each.
In a normal bowel, the sounds may be high-pitched gurgling sounds.
• If you don’t detect bowel sounds, there may be a problem, such as paralytic ileus or a bowel obstruction.
• High-pitched or tinkling sounds may correspond to a hyperactive bowel with increased peristalsis. They’re associated with diar-
rhea and typically occur anterior to an obstruction.

Abdominal quadrants

Right upper quadrant Left upper quadrant

• Right lobe of liver • Left lobe of the liver
• Gallbladder • Stomach
• Pylorus • Body of the
• Duodenum pancreas
• Head of the pancreas • Splenic flexure of
• Hepatic flexure of the the colon
colon • Portions of the
• Portions of the transverse and
ascending and descending colon
transverse colon

Right lower quadrant Left lower quadrant

• Cecum and appendix • Sigmoid colon
• Portion of the • Portion of the
ascending colon descending colon

September/October l LPN2007 33
 PATIENT EDUCATION
Postoperative wound care
CONNIE SARVIS, RN, CON(C), CWS, IIWCC, MN, FCCWS
Skin and Wound Consultant • Seven Oaks General Hospital • Winnipeg, Manitoba, Canada
If you recently had surgery, you may have questions
about caring for your surgical wound. Here’s what you
need to know.
How is the wound closed?
After surgery, the surgeon may close your wound with
stitches, staples, butterfly bandages (flexible skin-
closure tapes), or adhesive glue. Your surgeon will
make the best choice for you depending on the type of
surgery you had.
Stitches, the most common way to close wounds, are
made of nylon or silk suture material that looks like
thread or fishing line. Some types of stitches dissolve
after several days; others must be removed by your
nurse or surgeon after the wound has healed.
Staples are metal clips that hold the wound edges
together. Wounds closed with staples may heal faster
than those closed with stitches.
Butterfly bandages are small strips of paper tape that
are put across the wound edges to hold them together.
These bandages can be used alone or with staples and
stitches. They aren’t as secure as stitches or staples, so
your surgeon may not use them if you’ve had surgery in
the area before or have other medical conditions that
may delay healing.
Adhesive glue may be used on a small wound that’s
not very deep.
How long will healing take?
This depends on your general health and the type of
surgery you had. In healthy children and adults, most
wounds heal within 2 weeks. But healing will probably
take longer if you have a health problem such as dia-
betes, are taking certain drugs (such as steroids or
chemotherapy drugs), or have a weakened immune
system.
What can I do to help heal?
Eat a nutritious diet high in vitamin C, protein, and
zinc to promote wound healing. Citrus fruits and
green vegetables such as broccoli and Brussels sprouts
are rich in vitamin C. Meats and milk products are
high in protein and zinc. Your health care provider
may recommend multivitamins and nutritional supple-
ments depending on how well you’re eating.
34 LPN2007 l Volume 3, Number 5
How do I care for my wound?
Following your surgeon’s directions, keep the wound
clean and dry for the first 72 hours. Your surgeon will
tell you if you can shower after that. Avoid baths,
swimming pools, and hot tubs until your incision is
completely healed, or you might get an infection.
Your wound may be bandaged with gauze or anoth-
er type of dressing. Just before you go home, the sur-
geon or nurse may change the dressing, check the
wound, and put on a new dressing, depending on the
surgery.
If you go home with a dressing on your wound, you’ll
need to change it every 1 to 2 days, as directed, and
inspect the wound for redness, weeping, swelling, or
other problems. Wash your hands thoroughly with soap
and water before and after touching or changing the
dressing. Keep the dressing clean and dry while it’s still
on.
If you have butterfly bandages, they may peel slightly
a few days after surgery. Leave them alone until they fall
off.
You may have discomfort or numbness around the
wound at first; this is normal. Your surgeon will pre-
scribe medicine to keep you comfortable. For the first
few days after your operation, take your pain medicine
regularly or at the first sign of discomfort, as directed.
Notify your surgeon immediately if your pain suddenly
gets worse.
The wound may itch for a few days after surgery.
This may be normal, or it may be a sign of a problem,
such as infection or stitches that are too tight. Don’t
scratch the area; call your surgeon if you’re uncomfort-
able.
What about drains?
You may have a tube (drain) in the surgical site to re-
move excess fluid or blood, which is collected in a bag
or small container. Over about a week, you should see
less drainage, and it may change color; for example,
from dark red to pink to yellow. Many surgeons will
remove the drain when drainage is less than 30 mL (1
ounce). If you have a drain, empty the drainage bag
three times a day, following the procedure you were
taught in the hospital and taking care not to dislodge
or separate the drain from the bag.
 sounds (increased loudness, tone,
and regularity) to totally absent
bowel sounds, typical of a paralytic
ileus.
Constipation is a common sign of
small-bowel obstruction. However,
When can I get back to normal? in a partial obstruction, the patient
Moving around is good for you, but while your wound is heal- may have diarrhea and pass some
ing, avoid placing any strain on it. Also avoid bending, lifting, gas. In a complete obstruction, the
or being too active. Your surgeon will tell you when you can patient may have a bowel movement
resume picking up small children, doing heavy household if the obstruction is above the stool
chores, or carrying groceries. In the meantime, if you feel well that’s already in the bowel.
enough, you can continue light housework and activities de- Abdominal distension may be
pending on where the wound is located. Light exercise will also caused by obstructions in the lower
help you recover faster. Talk with your surgeon about your abdomen. With a complete obstruc-
normal activities so you know which ones are safe to do. tion, high-pitched bowel sounds can
Scars from surgical wounds are prone to sunburn, so keep be heard.
them covered or apply sunscreen once the wound is healed.
Consider using green-colored concealer under makeup to help Signs and symptoms of
hide a red scar. Lotions and skin softeners also can soften scars. large-bowel obstruction
Patients with a large-bowel obstruc-
When should I call my doctor? tion will usually have the following
Call your surgeon immediately if you experience any of the fol- signs and symptoms.
lowing signs and symptoms: Abdominal pain. A patient with
• chills or fever over 101°F (38.3°C) an obstruction in the large bowel
• warmth, swelling, redness, or more pain at the wound may describe pain as cramping, deep,
• pus, a bad smell, or more drainage than usual from the and long lasting. Acute pain may
wound or drain indicate strangulation or perforation
• sudden, excessive bleeding from the wound or drain of the bowel.
• a feeling of hardness or fullness around the wound or any Diarrhea or constipation. The
opening of stitches or staples. occurrence of constipation or diar-
If your wound pops open, cover it with gauze or a clean towel rhea will depend on whether the
moistened with salt water or clean water. Call your surgeon right obstruction is complete or partial.
away for more directions or go to the nearest emergency depart- Nausea and vomiting. This may
ment. be absent at first. As the large-bowel
This patient-education guide has been adapted for the 5th-grade level using the Flesch-Kincaid and obstruction worsens, the patient’s
SMOG formulas. It may be photocopied for clinical use or adapted to meet your facility’s requirements.
Selected references are available on request. vomit may smell like feces.
Abdominal distention. Bloating is
Special thanks to Tracy Kane, MEd, patient-education coordinator, Albert Einstein Health Care
Network, Philadelphia, Pa. more visible in patients with a large-
bowel obstruction.

Ask questions!
When a patient has abdominal pain
and complains of nausea and vomit-
ing, it’s critical that you begin your
assessment by taking a complete and
detailed history. Ask the patient
about his bowel habits, and find out

LPN2007
about any surprising changes. Ask
when he had his last bowel move-
ment. Were there prior surgeries?

September/October l LPN2007 35
 Abdominal trauma? Hernias? Peptic
ulcer disease? Does the patient ex-
perience constipation or indiges-
tion? Has he had gallstones? Tu-
mors? Radiation therapy to the
abdomen or the peritoneal area?
Has he ever had an eating disorder?
Find out about current and past
medications.
Be thorough as you ask your
patient about his current symptoms.
Ask about the location, duration, and
the type of pain. Ask what, if any-
thing, relieves the pain. Find out if
[ ]
Taking a complete and detailed history is
critical when a patient has abdominal pain
and complains of nausea and vomiting.
he has nausea or vomiting, and, if so,
with what frequency, consistency,
color, and odor.
Once you obtain a thorough histo-
ry, it’s time to assess the patient.
This is done through abdominal
inspection, auscultation, percussion,
and palpation. For a visual guide to
assessing bowel sounds, see Some
sound advice.
Testing, testing
After your initial assessment, the pa-
tient’s health care provider will or-
der a number of diagnostic tests to
determine the location, extent, and
severity of the obstruction. These
tests include:
• a complete blood cell (CBC) count to
look for signs of infection and dehy-
dration. An elevated white blood
cell count (15,000 to 20,000/mm3)
36 LPN2007 l Volume 3, Number 5
is a sign of infection and may indi-
cate bowel strangulation or perfora-
tion. An increased hematocrit level
may mean dehydration.
• an electrolyte panel and urinalysis to
evaluate fluid and electrolyte imbal-
ance and/or sepsis
• C-reactive protein and serum lactate
levels to assess renal function and in-
flammation as well as rule out other
problems
• creatinine and blood urea nitrogen
(BUN) levels; an increase in these
serum levels indicates that your pa-
tient may be dehydrated
• type and crossmatch (if there’s a
chance the patient needs surgical in-
tervention)
• abdominal X-rays, flat and upright
views to determine the location, pat-
tern, and types (mechanical or non-
mechanical, partial or complete) of
the obstruction
• computed tomography can also de-
termine the location and degree of
the obstruction; it’s about 90%
sensitive and specific in diagnosing
small-bowel obstruction and is
the preferred diagnostic imaging
test
• barium enema to determine the ex-
act location and confirm the pres-
ence of an obstruction (barium is
used with great caution, and not at
all if a perforation is suspected)
• colonoscopy to help in the assess-
ment and diagnosis of a large-bowel
obstruction
• oral barium/gastroscopy tests, which
can indicate an upper gastrointesti-
nal mass.
Medical and surgical
interventions
As soon as the health care provider
arrives at a definitive diagnosis, the
best course of action is to treat the
patient quickly to prevent bowel
perforation or strangulation. He
may receive medical treatment or
require surgery. Immediate surgery
is necessary if he has vascular insuf-
ficiency, perforation, or strangula-
tion of the bowel.
Medical treatment depends on the
extent and severity of symptoms, and
the type and location of the obstruc-
tion. In cases of malignant obstruc-
tions, the patient’s condition and
prognosis are important factors in
treatment decisions.
Treatment begins with conserva-
tive medical management, which is
often sufficient for partial small-
bowel obstruction or adhesions.
Conservative treatment includes:
• pain management
• controlling nausea with antiemetics
• decompression and emptying of
the gastrointestinal contents to re-
lieve distention and nausea
• inserting a nasogastric (NG) tube
to remove gastric drainage and aid
in decreasing nausea and vomiting
• administering intravenous fluids
and electrolytes to restore, balance,
and/or replace lost fluid. The types
and amounts of fluids ordered de-
pend on the results of lab tests and
the overall condition of the patient.
If surgery is required, the health
care provider may order antibiotics
to minimize the risk of infection that
may result from the contents of the
intestines spilling into the peritoneal
and abdominal cavities. The choice
of surgical procedure depends on the
type and location of the bowel
obstruction.
Surgery in the small bowel can be
a resection with end-to-end anasto-
mosis. In this procedure, the surgeon
removes the diseased tissue and reat-
taches either end of the healthy
intestinal tissue to the other.
When surgery is chosen for a
large-bowel obstruction, the pre-
dominant cause of the obstruction is
often a malignant tumor. If there’s
perforation or diverticula, the
surgery may be a resection with
anastomosis. If there’s a tumor in the
colon, a hemicolectomy (removal of
the diseased part of the colon) may
be appropriate.
Nursing care after diagnosis
Once a patient is diagnosed with a
bowel obstruction, it’s crucial to
completely assess his physiologic
and psychological needs and to keep
him safe. All three are important,
but he may have a particularly diffi-
cult time dealing with body image
issues if he needs an ostomy, a sur-
gically created opening in the body
for the discharge of body waste. (A
colostomy is created for problems
associated with the blockage of the
large intestine. An ileosotomy is an
opening created for problems in the
small intestine.) This is when your
support, understanding, and ability
to educate are an essential part of
your patient care.
Conquering complications
During treatment, your patient’s vi-
tal signs can serve as a potential
warning of complications. If his
temperature is elevated, it could be
a sign of infection or possible perfo-
ration. When you take his pulse, be
aware that tachycardia can be re-
lated to possible hypovolemic shock
or septicemia.
When you measure blood pres-
sure, keep in mind that hypotension
is secondary to low circulating fluid
volume. Make sure enough oxygen is
available in the patient’s blood to
supply his tissues.
Carefully monitor the patient’s
fluid and electrolyte balance. What’s
the intake and output? Hydration is
very important to maintain renal
function and tissue perfusion, to pre-
vent shock, and to maintain adequate
blood pressure.
Monitor your patient’s lab results,
such as CBC and serum creatinine,
amylase, and BUN levels. The
results will indicate if the problem is
worsening or resolving. Notify the
health care provider of any abnormal
results.
If your patient has abdominal dis-
tention, measure his girth every shift.
Each time, make sure the patient is in
the supine position if he’s comfortable
and it’s not contraindicated; use the
same measuring tape, measure at the
same time, and mark the site on his
abdomen to ensure accuracy.
Postop care
After a patient undergoes surgery
for a bowel obstruction, be aware of
any changes in his vital signs, hydra-
tion, fluid, electrolytes, abdominal
distention, and comfort. Determine
if his bowel function has improved
by noting the absence of nausea and
vomiting. Listen for bowel sounds
and note any expulsion of flatus and
stools. Look for a decrease in ab-
dominal distention. Measure the pa-
tient’s urinary output. Listen for
improved lung sounds.
Notice what the patient says and
does. Can you detect a reduction in
his anxiety? Has his pain lessened?
Examine the incision. Is there
drainage from the wound? Skin sep-
aration at the point of incision?
Unusual lung sounds? Foul-smelling
or unclear urine? If your patient
returns from surgery with an osto-
my, assess the stoma and be sure the
pouch protects the skin and contains
drainage. Comfort and reassure the
patient. Teach him what to expect
during his recovery period. Be sure
to include the patient’s family and
caregivers in the plan of care when
appropriate.
Taking care of pain
In terms of pain management,
administer all medications as pre-
scribed and assess for adverse
effects. Medications may include
opioids or opioid derivatives (note
that morphine increases nausea and
vomiting and causes constipation).
Pain medications are also useful to
control the patient’s anxiety. An
example of a drug to manage pain
is morphine sulfate (MS Contin).
The administration route will de-
pend on the patient’s overall condi-
tion.
When combined, antiemetic and
opioid drugs depress the central ner-
vous system. Be alert for changes in
the patient’s mental status and for
signs and symptoms of respiratory
depression and hypotension.
While your patient can’t take
nutrition by mouth, provide good
mouth care. Use a water-soluble
lubricant for lip care and care of the
nasal mucosa. If he has an NG tube
in place, provide the appropriate care
for the tube as well as for the patient.
When your patient is ready to eat,
usually within 24 to 48 hours after
surgery or at the first sounds of peri-
stalsis, a progressive diet will be
ordered as tolerated.
Provide comfort measures to
bring relief when possible. Simply
raising the head of the bed to 45
degrees helps the patient breathe
better and can help create a more
restful environment.
Be sure to provide psychological
comfort and reassurance. Include
family members in your care and
patient education.
September/October l LPN2007 37
 Infection prevention
In addition to prescribing opioid
and analgesic medications, the
health care provider may order
broad-spectrum antibiotics such as
cefotetan (Cefotan) or cefuroxime
(Ceftin) to prevent the possibility of
infection. The patient may also re-
ceive metronidazole (Flagyl) in
combination with antibiotics to
protect against anaerobic bacteria.
The type of antibiotic depends on
the microorganism’s susceptibility.
The route of administration de-
pends not only on the patient’s
condition but on the action of the
drug.
foods. Teach him to recognize signs
and symptoms of recurrent prob-
lems, such as infection, so he’ll
know when to seek help from his
health care provider.
A complex condition
Unlike some other dysfunctions, a
bowel obstruction can be a complex
condition to diagnose. You must be
aware of the clues that help deter-
mine where the obstruction is lo-
cated. Whether the problem is
managed medically or through sur-
gical intervention, your participation
throughout the process will go a
long way in helping the patient
achieve a speedy recovery. LPN
Selected references
Freeman LC. Responding to small-bowel obstruc-
tion. Nursing2007. 37(5):56hn1-56hn2, May 2007.
McCowan C. Obstruction, large bowel. eMedi-
cine. http://www.emedicine.com/emerg/topic
65.htm. Accessed July 2, 2007.
Milenkovic M, et al. Hospital statistics for GI dis-
eases 2004. Health Care Utilization Project. Statisti-
cal Brief # 12:1-7, 2006.
Nobie B., Khalsa S. Obstruction, small bowel.
eMedicine. http://www.emedicine.com/emerg/
topic66.htm. Accessed July 2, 2007.
Schmelser L. Nursing management of lower in-
testinal problems. In SL Lewis, et al (eds). Med-
ical-Surgical Nursing: Assessment of and Management
of Clinical Problems, 7th edition. St. Louis, Mo.,
Mosby-Elsevier, 2007.
Smeltzer SC, et al. Brunner & Suddarth’s Textbook
of Medical-Surgical Nursing, 11th edition. Phila-
delphia, Pa., Lippincott Williams & Wilkins,
2006.
Trouble down below: Understanding small bowel
obstruction. Nursing2005. 35(7):32cc4-32cc7,
2005.

Patient teaching
Explain to your patient the purpose
of any tubes and clarify the se- On the Web
quence of procedures to alleviate
his anxiety. Advise the patient to en- International Foundation for Functional Gastrointestinal Disorders:
gage in the level of activity that’s http://www.iffgd.org/GIDisorders/GIAdults.html
appropriate for his condition. Teach Society of Gastroenterology Nurses and Associates, Inc.:
him how and when to take his pre- http://www.sgna.org/Resources/standards.cfm
WebMD Digestive Disorders Health Center:
scribed medications. Counsel the
http://www.webmd.com/digestive-disorders/tc/
patient to drink plenty of fluids if
Bowel-Obstruction-Topic-Overview
not contraindicated and when ap-
plicable and to choose nutritious

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Caring for a patient with a bowel obstruction
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center.com. Call 1-800-787-8985 for details.
PROVIDER ACCREDITATION
Lippincott Williams & Wilkins, publisher of LPN2007, will award 2.0 contact hours for
this continuing nursing education activity.
Lippincott Williams & Wilkins is accredited as a provider of continuing nursing educa-
tion by the American Nurses Credentialing Center’s Commission on Accreditation.
Lippincott Williams & Wilkins is also an approved provider of continuing nursing
education by the American Association of Critical-Care Nurses #00012278 (CERP cate-
gory A), District of Columbia, Florida #FBN2454, and Iowa #75. Lippincott Williams &
Wilkins home study activities are classified for Texas nursing continuing education
requirements as Type 1. This activity is also provider approved by the California Board
of Registered Nursing, Provider Number CEP 11749, for 2.0 contact hours.
Your certificate is valid in all states.

38 LPN2007 l Volume 3, Number 5